But low cholesterol is good, right?
August 20, 2010 6:45 AM   Subscribe

What should I do about a reported low HDL and high LDL/HDL ratio?

At a wellness screening at work yesterday I was in the normal or acceptable range for body fat %, fasting glucose, and LDL (181), but my HDL was a very low 18, making my LDL/HDL ratio basically a 10 a region of high risk. In doing the standard internet searching about how to deal with a low HDL, I haven't found much that seems useful. Things I've found include

  • exercise more : I've been exercising a few days a week since April.
  • lose weight : At 20% body fat I'm working on this, but I'm in a 'acceptable range'.
  • Quit smoking: I've never smoked.
  • Eat more fiber: I've been on a mostly vegetarian diet for the past few years, and have been having oat filled granola for breakfast for the past month.
  • Eat less trans-fats: This is trickier since I haven't been paying attention to trans fats, but a quick survey of package goods in my house has none show up. At home I don't eat many pre-packaged foods. I do eat out a lot, so I probably can do something here.

    which leaves me with

  • Drink 1-3 servings alcohol a day: This conflicts with my weight loss goal since I'd rather have non-empty calories, but, I could do this... My average alcohol intake is somewhere from 1-3 a week, not a day at this point.

    Most of the cholesterol info I could find was about reducing your totals, not increasing your HDL. Is there anything obvious I'm missing above? Or am I perhaps discounting the efficacy of a further change above? Or is this something that a healthy 32 year old doesn't need to worry about much, and just get retested again in a few months?
  • posted by garlic to Health & Fitness (19 answers total) 4 users marked this as a favorite
    You should bring it up with your physician at your next appointment and see what he/she says. They can put these numbers in perspective relative to your overall health, figure out if/when it makes sense to intervene with drugs, help you figure out whether you should even worry about it, etc.
    posted by Inspector.Gadget at 6:49 AM on August 20, 2010

    this article lists 10 ways to increase your HDL the items you list are mostly in the bottom 5 - I don't know if they're ranked by importance, but it may give you some ideas.
    How is your consumption of 'good fats' (eg. olive oil, avacado, nuts etc)?
    posted by missmagenta at 6:57 AM on August 20, 2010

    1-3 servings alcohol a day?

    I showed up as having lardy blood a few years ago, and brought it down a fair amount over the next couple of years by cutting down on fatty food and taking more exercise. But it was still over the "safe" level, so eventually I was called in to see the doctor rather than the nurse. His recommendations:

    1. Swimming, rather than the more gentle forms of exercise I'd been doing.
    2. Plant stanol esters (Benecol is a popular brand here).
    3. Don't be paranoid about cheese, the "mediterranean diet" includes cheese and that's healthy.
    4. Lardy blood is not the only risk factor - he went through the research in detail with me, including all the factors (immediate family with heart disease, smoking history, weight, diet, etc) and concluded that it's not an immediate problem, my blood is abnormal but other factors compensate for that.

    I think the main conclusion is that "LDL/HDL TOO HIGH YOU ARE GOING TO DIE SOON" is a simplistic response, and sometimes simplistic responses are needed in medical tests to flag up things that need to be looked at in more depth, but they aren't the whole story.
    posted by nja at 6:58 AM on August 20, 2010 [1 favorite]

    Oh yes, I have a friend who swears that high consumption of avocado brought her ratio down enormously. Anecdotes are not evidence, but avocados are lovely.
    posted by nja at 6:59 AM on August 20, 2010

    Yeah, talk to your doctor. Cholesterol is hard and doesn't always make sense - my BMI is 45, I eat all the wrong things, and my total cholesterol is 84 (40 HDL, 44 LDL) and has been for years; the first time they went back and did it again just to be sure. Two doctors have jokingly threatened me with fish, but they said not to worry unless the HDL drops more.
    posted by SMPA at 7:03 AM on August 20, 2010

    I've been on a mostly vegetarian diet for the past few years, and have been having oat filled granola for breakfast for the past month.

    Carbohydrates makes your HDL go down and your LDL (and triglycerides) go up. Granola is sugary as hell, and most vegetarian diets lean heavily on starches and sugars.

    Completely contrary to what would seem like common sense, a high-fat, lower-carb diet can reduce your LDL and increase your HDL, provided your calories mostly come from animal fat and some vegetable fat sources like olive oil and coconut. However, because fat is so calorie-dense, most of the quantity of your diet should come from non-starchy vegetables. Think: collard greens with bacon.
    posted by overeducated_alligator at 7:04 AM on August 20, 2010 [5 favorites]

    Niacin is supposed to help: "Niacin, a B vitamin, has long been used to increase high-density lipoprotein (HDL), the "good" cholesterol. HDL cholesterol helps sweep up low-density lipoprotein (LDL), or "bad" cholesterol, in your bloodstream. Although niacin is readily available and effective, it hasn't gotten much attention compared to other cholesterol drugs. "
    posted by Blake at 7:15 AM on August 20, 2010

    IANAD but according to the AMA and various other sources, an LDL of 181mg/dl is high not normal/acceptable so its not just the ratio you should be concerned about. You might want to consider checking in with your Dr just to be on the safe side.
    posted by missmagenta at 7:21 AM on August 20, 2010

    sorry = AHA not AMA
    posted by missmagenta at 7:24 AM on August 20, 2010

    overeducated_alligator has the ticket. I eat a high fat diet, with grains and sugars only very rarely, and my doctor always marvels that I'm the only patient he has whose HDL is higher than her LDL.

    If you're interested in a little popular science behind this kind of thing, you could check out Good Calories, Bad Calories by Gary Taubes.
    posted by telegraph at 7:25 AM on August 20, 2010

    A year ago my total cholesterol was 175, with an HDL of 31. I started taking 2 grams of fish oil a day. I made no other dietary or lifestyle changes.

    In June my total cholesterol was 161 with an HDL of 71.

    Couldn't hurt to try it!
    posted by elsietheeel at 7:28 AM on August 20, 2010

    Niacin is one of those "best to talk to your GP first" vitamins-- there's a few types that don't help cholesterol, and the flushing side effect bites (and can be worked around in most cases). Take your results to your dic, ask about fish oil and niacin, and let them work something out for you.
    posted by fairytale of los angeles at 7:40 AM on August 20, 2010

    "Vegetarian diet" can mean a lot of things . When I was single, it was always sauteed vegetables and pasta, then I tried more boiled/steamed vegetable sides with less carbs and my cholesterol balances have been better.
    posted by bonobothegreat at 8:08 AM on August 20, 2010 [1 favorite]

    Not seen it mentioned so far, cranberry juice (light or diet; too much sugar in the regular) in varying amounts shows up as a recommendation around the internet: google "cranberry juice" & "cholesterol".

    Agree, too, that such numbers as the OP described call for an extended conversation with his/her regular doctor.
    posted by 5Q7 at 8:14 AM on August 20, 2010

    Increase your fat intake. Since you are a vegetarian, I would recommend snacking on macadamia nuts and a fish oil/DHA supplement.

    If you are brave and willing to accept that maybe conventional wisdom regarding fat is wrong, coconut fat is known to increase HDL. I eat coconut fat every day and my HDL is great and my LDL is low.
    posted by melissam at 8:24 AM on August 20, 2010

    Here's the thing about cholesterol tests. They are not at all accurate unless you have been fasting for a period of time (usually 8-12 hours) beforehand.

    Go to your regular physician and get your cholesterol checked first thing in the morning, before you eat. Then you can start worrying about cholesterol--after you talk with your doctor about these various other factors: your age (clinically you are too young to have cardiovascular disease); your risk for diabetes or pre-diabetes (which is often co-morbid to cardiovascular disease); your family's history with cholesterol; and how any medications that you are taking now may affect your cholesterol numbers. (Some women, for instance, find that the hormones in their birth control pills raise their bad cholesterol.) These are just some of the factors that your doctor will consider.

    I'm another example of strange cholesterol outcomes. This January, my HDL was 86, my LDL was 90-something and my triglycerides were low. However, my total cholesterol was something like 270. My sister and mother are the exact same way. I am 31 and was given the vague advice to limit my portions and exercise more. My husband, who is 38, has a father who has had angioplasty, stents placed and, almost a year ago, bypass surgery--and he's not even 60. My husband was put on a statin because of this, even though his total cholesterol was just over 200.

    There's so much more to the story than a wellness fair cholesterol test. Good for you for wanting to take action on it, but don't get too worked up over it.
    posted by FergieBelle at 9:19 AM on August 20, 2010

    If you're interested in doing some of your own sleuthing, I *think* whether or not any of this actually matters at all (that is, whether or not you should change your lifestyle) is tremendously controversial:


    Just another way to think about your situation.
    posted by zeek321 at 1:13 PM on August 20, 2010 [1 favorite]

    To increase your HDL, you need more good fats, and it would help to use the good fats to replace bad fats. Try avocados as a flavoring instead of cheese, use olive/veg oil in place of butter, and add fatty fishes like salmon to your diet.

    We did this to help my husband raise his HDL; everyone is different, but it sure worked for him.
    posted by Knowyournuts at 2:33 PM on August 20, 2010

    Oh, I was just reading some articles for my own information, and I found something that might interest you. I had to come back here and comment. It turns out that dietary sugar can have a deleterious effect on HDL. To raise HDL levels, decrease sugar intake.
    posted by Knowyournuts at 10:18 AM on August 31, 2010

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